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1、第43卷第5期哈尔滨医科大学学报Vo.l43,No.52009年10月JOURNALOFHARBINMEDICALUNIVERSITYOct.,2009493缺血性结肠炎的临床特征及诊治探讨1,23221*裴凤华,徐长妍,高善玲,刘冰熔,迟宝荣(1.吉林大学第一医院肝病科,吉林长春130021;2.哈尔滨医科大学第二临床医学院消化内科,黑龙江哈尔滨150081;3.吉林大学第一医院病案室,吉林长春130021)[摘要]目的探讨缺血性结肠炎的临床特征、内镜下表现及治疗方法,提高对本病的认识,降低病死率。方法回顾性分析东北地
2、区2家医院收治的30例缺血性结肠炎病例临床资料,其中男性13例,女性17例。结果30例患者中,平均年龄599岁,50岁以上多见(733%)。急性25例,亚急性2例,慢性3例。临床表现以腹痛(933%),便血(833%),腹泻(433%)最多见。外周血白细胞计数733%超过正常,腹部B超检查80%提示肠管病变,腹部CT提示肠道病变。行结肠镜检查26例,病变部位多见于乙状结肠(556%)和降结肠(519%),镜下表现为黏膜充血、水肿(963%),糜烂(889%),与周围黏膜分界清晰(815%),多发溃疡(407%),有血迹(296%),肠管狭窄
3、(259%)等。27例行内科治疗(止血,改善肠道血液供应,抗凝,抗生素,营养支持等),3例行手术治疗,治愈率为233%(7/30),缓解率为667%(20/30),无死亡患者。结论缺血性结肠炎多见于老年人,症状不典型,及时行结肠镜检查和影像学检查是提高诊断率的有效方法。对本病认识的提高,早期行抗凝,改善血液循环或手术治疗,可提高总体疗效,降低病死率。[关键词]缺血性结肠炎;老年人;结肠镜;诊断;治疗[中图分类号]R574.62[文献标识码]A[文章编号]1000-1905(2009)05-0493-04Clinicalanalysisof30pati
4、entswithischemiccolitisPEIFeng-hua,XUChang-yan,GAOShan-ling,etal(DepartmentofHepatopathy,TheFirstHospital,JilinUniversity,Changchun130021,Ghina)Abstract:ObjectiveToanalyzeclinicalandendoscopefeaturesofischemiccolitis(IC).Torecognizethisdiseaseanddecreasefatalityrate.MethodsThirtypatie
5、ntswithischemiccolitiswereretrospective-lyanalyzedintwonortheasthospitals.ResultsMeanagewas59.5yearsold.Mostpatientsofcasesweremorethanfiftyyear-old(73.3%).Twenty-fivepatientswereacutecases,2patientsweresubacuteand3patientswerechroniccases.Clinicalfeaturesofischemiccolitiswereabdominal
6、pain(93.3%),hemafacia(83.3%)anddiarrhea(43.3%).Peripheralwhitebloodcellscountexceededinmostofthesepatients(73.3%).B-ultrasonographyshowedintestinalcanalof80%caseswereabnorma.lTwen-ty-sixpatientsacceptedcoloscopy.Thecoloscopefeaturesweremucoushyperemia(96.3%),erosion(88.9%),ulcers(40.7%)
7、,bloodstain(29.6%)andstenochoria(25.9%).Twenty-sevenpatientsac-ceptedtreatmentofinternalmedicine,3patientsacceptedsurgicalintervention.Cureratewas23.3%andremissionratewas66.7%.Nopatientdied.ConclusionIschemiccolitismostlyoccursinagedpeople.Theclinicalmanifestationofischemiccol
